Surviving sepsis: New guidelines harness life saving evidence for treating adults

An international team of experts recently came together to update sepsis care guidelines for adults for the first time since 2021.

The updates have profound implications for the management of sepsis, which is responsible for approximately 11 million deaths per year worldwide.

Co-led by University of Michigan's Hallie Prescott, M.D., and Massimo Antonelli, M.D. of Catholic University in Rome, Italy, the 69-person panel reviewed research, concentrating on areas of care that may have new evidence supporting a change in practice.

Some of the highlights of the new guidelines included factoring in what happens with a patient at risk of sepsis before they even reach the hospital.

“We included a conditional recommendation about screening for sepsis in an ambulance or a life-flight en route to the hospital,” said Prescott, who is the Toews Family Legacy Professor of Pulmonary and Critical Care Medicine at the University of Michigan Medical School.

Approximately half of patients with sepsis arrive at the hospital via ambulance, a period during which timely treatment could be initiated.

The panel recommended using a standard sepsis screening tool to identify these patients sooner.

In addition, patients with probable sepsis, low blood pressure, and who are facing prolonged travel time to the hospital are recommended for antimicrobial therapy while en route to hospital.

However, this does not mean all patients should have antibiotics delivered en route, cautioned Prescott.

In fact, more judicious medication prescribing practice is the focus of several of the new recommendations.

New evidence from U-M infectious disease and critical care experts suggests that the type of antibiotic administered should be more carefully considered.

“Specifically, we have new recommendations to not use anti-anaerobic antibiotics in patients at low risk for an anaerobic infection,” said Prescott.

The vast majority of lung and urinary tract infections—some of the most common conditions leading to sepsis—are almost always caused by aerobic bacteria, which thrive in oxygen-rich environments.

Use of broad-spectrum antibiotics, which target all types of bacteria, kill off the gut microbiome and lead to higher mortality, according to studies done at U-M.

The new guidelines also recommend not using empiric anti-fungal therapy outside rare case-by-case situations in patients are at very high risk of fungal infection.

For some clinical questions, there was insufficient evidence for the panel to make a recommendation.

These areas should be priorities for future research.

The guidelines include “in our practice” statements summarizing the panel’s approach in these situations.

While not formal recommendations, these statements provide some information on how the expert panel approach situations characterized by uncertainty, absence of data, or context-specific clinical variability.

The guidelines, which are published in the journal Critical Care Medicine and the European-journal Intensive Care Medicine, represent months of intensive work by a diverse panel of experts, including many from low and middle-income countries that bear the highest burden of the world’s sepsis cases.

“Over time, there has been an increasing attempt to move guidelines away from a bunch of experts in a room discussing what they do, toward implementing a very rigorous, structured methodological process,” said Prescott.

Prescott is the sepsis physician lead for the Michigan Hospital Medicine Safety Consortium, and has led efforts to develop, test, deploy, improve and share tools to help hospitals anywhere care for patients with sepsis. HMS is a Collaborative Quality Initiative funded by Blue Cross Blue Shield of Michigan, which unites hospitals across Michigan in efforts to improved care and has its coordinating center based at U-M.

The HMS Sepsis Initiative has published a Sepsis Toolkit  that hospitals can use to carry out quality improvement efforts to foster appropriate, evidence-based care for hospitalized medicine patients with sepsis. 

The full list of authors is available on the paper.

Paper cited: “Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026,” Critical Care Medicine. DOI: 10.1097/CCM.0000000000007075